Healthcare Provider Details

I. General information

NPI: 1417721937
Provider Name (Legal Business Name): TINA VUONG FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 S SAN VICENTE BLVD BLDG 3100
LOS ANGELES CA
90048-3311
US

IV. Provider business mailing address

127 S SAN VICENTE BLVD BLDG 3100
LOS ANGELES CA
90048-3311
US

V. Phone/Fax

Practice location:
  • Phone: 626-310-2147
  • Fax:
Mailing address:
  • Phone: 626-310-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95026213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: